Debunking Myths and Updating Your Exercise Science
NASM Educational Workshop
Developed by:
Fabio Comana, MA., MS..NASM CPT, CES & PES; NSCA CSCS; ACSM EP-C; ACE CPT & HC; CISSN.
Faculty Instructor – NASM, SDSU and UCSD.
Workshop Objectives:
1.
2.
3.
4.
5.
Describe new updates to the USDA Dietary Guidelines.
Discuss emerging research in sugar and disease.
Explain new discoveries associated with fat intake.
Summarize key principles and applications of the energy pathways.
Distinguish true HIIT programming from more appropriate programming
solutions for clients.
6. Develop and deliver alternatives to traditional HIIT workouts.
7. Demonstrate proper mechanics and technique to many popular exercises.
8. Describe the relationship of stability and mobility throughout the kinetic
chain.
9. Administer and interpret observations from NASM’ overhead squat
movement screen.
10. Design and implement a systematic corrective exercise program that delivers
client solutions.
Workshop Curriculum:
Time
Material Covered
0:00 – 0:10
Introduction
0:10 – 0:35
USDA Dietary Guidelines Updates
0:35 – 1:15
Sugar and Disease.
1:15 – 1:50
Emerging Research in Fat
1:50 – 2:25
Energy Pathways – Overview
2:25 – 3:05
HIIT Solutions
3:05 – 3:35
Lunch
3:35 – 4:25
Upper and Lower Extremity Movement Mechanics
4:25 – 5:05
Stability-Mobility: NASM overhead squat movement screen
5:05 – 5:50
Corrective Exercise
5:50 – 6:00
Closing Remarks
2015 – 2020 USDA Dietary Guidelines
Updates
USDA Guidelines
Updates
USDA Guidelines Update…
Release January 11, 2016
1.
2.
3.
4.
5.
Follow a healthy eating pattern across lifespan – all food and beverage
choices matter. Choose a healthy eating pattern with appropriate kcal level to
help achieve/maintain healthy body weight, support nutrient adequacy, and
reduce risk of chronic disease.
Focus on variety, nutrient density, and amount – to meet nutrient needs
within kcal limits, select a variety of nutrient-dense foods across/within all
food groups in recommended amounts.
Limit kcal from added sugars and saturated fats, and reduce sodium intake.
Reduce quantity of foods-beverages higher in these components to levels that
fit within healthy eating patterns.
Shift to healthier food-beverage choices – select nutrient-dense foodsbeverages across/within all groups v. less healthy choices, but cultural and
personal preferences to make shifts easier to accomplish and maintain.
Support healthy eating patterns for all. Everyone plays a role in helping
create/support healthy eating patterns in multiple settings nationwide – from
home to school, to work, and to communities.
USDA Guidelines Update…
In more detail:
A healthy eating pattern includes:
•
•
•
•
•
•
Variety of vegetables from all of the subgroups—dark green, red and orange, legumes
(beans and peas), starchy, and other.
Fruits, especially whole fruits.
Grains, at least half of which are whole grains.
Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages.
Variety of protein foods, including seafood, lean meats and poultry, eggs, legumes
(beans and peas), and nuts, seeds, and soy products.
Healthy oils.
A healthy eating pattern limits saturated fats, trans fats, added sugars, and sodium:
•
•
•
•
Consume < 10% of calories per day from added sugars (new) – v. 10% for all sugars.
Consume < 10% of calories per day from saturated fats (same).
Consume < 2,300 milligrams (mg) / day of sodium (same).
If alcohol is consumed – consume in moderation (≤1 drink/day – women and ≤ 2
drinks/day – men) (same).
USDA Guidelines Update…
Food Group
Amount*
Vegetables
2½ cup eq./day
• Dark green
1½ cup eq./week
• Red and orange
5½ cup eq./week
• Legumes (beans, peas)
1½ cup eq./week
• Starchy
5 cup eq./week
• Other
4 cup eq./week
Fruits
2 cup eq./day
Grains
6 oz. eq./day
• Whole grains
≥ 3 oz. eq./day
• Refined grains
≤ 3 oz. eq./day
Dairy
3 cup eq./day
Protein Foods
5½ oz. eq./day
• Seafood
8 oz. eq./week
• Meats, poultry, eggs
26 oz. eq./week
• Nuts, seeds, soy products
4 oz. eq./week
Oils
27 g/day
Discretionary kcal (% total)
270 kcal/day (14%)
Food Group
Serving Size
Vegetables
•
•
½ cup chopped = ½ cup equivalent.
1 cup raw (leafy) = ½ cup equivalent (new).
Fruits
•
•
•
½ cup fresh/frozen fruit = ½ cup equivalent.
½ cup juice = ½ cup equivalent.
¼ cup dried fruit = ½ cup equivalent.
Grains
•
•
•
1 oz. (~ 1 slice) grains = 1 oz. equivalent.
½ cup cooked grains = 1 oz. equivalent.
1 cup unsweetened cereal (¾ cup sweetened)
= 1 oz. equivalent.
Dairy
•
•
•
8 oz. dairy = 1 cup equivalent.
8 oz. fat-free yogurt = 1 cup equivalent.
1½ oz. cheese = 1 cup equivalent.
Proteins
•
•
•
•
•
1 large egg = 1 oz. equivalent.
1 TBL peanut butter = 1 oz. equivalent.
1 oz. nuts/seeds = 2 oz. equivalent (new).
½ cup beans = 2 oz. equivalent (new).
1 oz. meat = 1 oz. equivalent.
USDA Guidelines Update…
Current Dietary Intakes v. Recommended
• Approx. ¾ population
follows diet low in
vegetables, fruits, dairy, and
oils.
• Over ½ population meets or
exceeding total grain and
total protein foods
recommendations.
• Most Americans exceed
recommendations for added
sugars, saturated fats, and
sodium
USDA Guidelines Update…
Nutrient
Ref
Kcal
Child
1-3
Female
4-8
Male
4-8
Female
9-13
Male
9-13
Female
14-18
Male
14-18
Female
19-30
Male
19-30
Female
31-50
Male
31-50
Female
51+
Male
51+
1,000
1,200
1,400 1,600
1,600
1,800
1,800
2,200,
2,800,
3,200
2,000
2,400,
2,600,
3,000
1,800
2,200
1,600
2,000
Protein (g)
RDA
13
19
19
34
34
46
52
46
56
46
56
46
56
Protein
(% kcal)
AMDR
5-20
10-30
10-30
10-30
10-30
10-30
10-30
10-35
10-35
10-35
10-35
10-35
10-35
CHO
(g)
RDA
130
130
130
130
130
130
130
130
130
130
130
130
130
CHO
(% kcal)
AMDR
45-65
45-65
45-65
45-65
45-65
45-65
45-65
45-65
45-65
45-65
45-65
45-65
45-65
Fiber
(g)
14g/1,000
kcal
14
16.8
19.6
22.4
25.2
25.2
30.8
28
33.6
25.2
30.8
22.4
28
Added
sugars
(% kcal)
DGA
<10%
<10%
<10%
<10%
<10%
<10%
<10%
<10%
<10%
<10%
<10%
<10%
<10%
Total fat
(% kcal)
AMDR
30-40
25-35
25-35
25-35
25-35
25-35
25-35
20-35
20-35
20-35
20-35
20-35
20-35
Sat fat
(% kcal)
DGA
<10%
<10%
<10%
<10%
<10%
<10%
<10%
<10%
<10%
<10%
<10%
<10%
<10%
Linoleic
acid (O-6)
AI (g)
7
10
10
10
12
11
16
12
17
12
17
11
14
Linolenic
acid ALA)
AI (g)
0.7
0.9
0.9
1
1.2
1.1
1.6
1.1
1.6
1.1
1.6
1.1
1.6
Sugar and Disease
Sugars
Research
Sugars …
Simple Sugars = monosaccharides and disaccharides.
•
•
3 nutritionally important monosaccharides:
Same chemical structure (C6H12O6).
Classification
Description
# Units
Sources
Monosaccharides
Smallest CHO unit.
Only absorbable forms
1 unit
Glucose, Fructose, Galactose
ONLY glucose = Insulin response
Nutrient
Galactose
Glucose
Fructose
Mechanism
Glucose Active absorption = faster uptake rates.
Galactose • Glucose = fuel + storage form in body
• Galactose = structural compound at cell
membrane / liver conversion to glucose or
fat.
Fructose
Facilitated absorption = slower uptake rate.
• Can cause GI distress.
• Fructose = liver conversion to glucose or fat.
Sugars …
Classification
Description
# Units
Sources
2 units
• Sucrose = 1 glucose + 1 fructose,
• Lactose = 1 glucose + 1 galactose
• Maltose = 2 glucose
Most Sweeteners
Disaccharides
Lactose Intolerant
Simple Sugars
Maltose
Lactose
Galactose + Glucose
Glucose + Glucose
Sucrose
Glucose + Fructose
Brown sugar
Sucrose or Sugar
Corn syrup
Molasses
High fructose corn
syrup (HFCS)
Maple sugar
Caramel
Brown rice syrup
Fructose
Glucose
Lactose
Date sugar
Molasses powder
Maple syrup
Fruit sugar
Dextrose
Honey
Dextrin
Sugars …
Sugars v. High Fructose Corn Syrup (1960s).
•
•
Group of corn starches (glucose polymers) undergoing enzymatic processing –
increases fructose content, then mixed with pure corn syrup (~ 100% glucose).
Common HFCS form = HFCS 55 (55% fructose) – most commonly used.
 Comparable sweetness to sucrose; cheaper alternative.
Does HFCS contribute to obesity?
• Same rate as natural sugars (caloric density: 1 g = 4 kcal).
• Coincidental entry to market with start of obesity epidemic (1970s).
Does HFCS contribute to diabetes?
• Perhaps little more than sugar given new research on fructose and obesity (leptin
resistance), and diabetes.
Does HFCS cause any other health concerns?
• Yes, elevated levels of reactive carbonyls – 10x higher in HFCS (elevated in diabetics).
• Believed to accelerate tissue damage (vascular, nerve).
Sugars … Current Intakes …
Men
Women
Current Guidelines*
Total CHO Intake
48.0 % of total kcal
51.0 % of total kcal
45 – 65% of total kcal
Sugar Intake
24.2 % of total kcal
(13% added sugar)
25.3 % of total kcal
(13% added sugar)
≤ 10 % of added sugar
• Total sugar consumption = 130 lbs. each year (adults) (45 lbs. of sucrose).
o 39 % increase since 1950.
o Average adult = 22 tsp per day (children = 23 tsp per day).
o Equivalent to 848 cans of 12 oz. (355 mL) soda / year.
• HFCS consumption = 35 lbs. each year (adults).
* 2014 – World Health Organization (WHO) recommendation for total sugar intake =
aim for ≤ 5 % of total kcal
• New USDA Guidelines: 10% added sugar = 12 tsp per day.
Sugars … Current Intakes …
American Heart Association
(AHA)
Center for Science in the Public Interest
(CSPI)
Women
6 tsp. added sugar
100 kcal (6½ tsp.) added sugar
Men
9 tsp. added sugar
150 kcal (9½ tsp.) added sugar
Added Sugars to US Diet
Mixed Dishes
Diary
Grains
4%
2%
Spreads, Dressings,
Condiments, etc.
6%
Beverages (not milk
or juice)
8%
47%
31%
Snacks and Sweets
Vegetables
1%
Fruit and Fruit Juice
1%
Diabetes and Inflammation …
Two types – affects 29.1 million adults (9.3% of population).
•
•
•
•
Type I: 5 – 10% of diabetics (no insulin production).
Type II: 90 – 95% of diabetics (adequate insulin – receptor resistance).
Almost ½ US adults have Diabetes / Pre-diabetes (86 million – up from 79m).
Cost = $245 billion (2012).
Study: 75,000 nurses and 39,000 health professionals (22 years)
• Sugary drink ≥ 1 per day = 30% increased for diabetes risk v. ≤ 1 per month.
• Fruit juice ≥ 1 per day = 21% increased for diabetes risk v. ≤ 1 per week.
Diabetes and Inflammation …
Blood sugar fluctuates constantly throughout day.
• Glycohemoglobin (HbA1c) – glycated hemoglobin (sugar bound to Hgb in red
blood cells) represents chronic blood glucose levels (previous 8 weeks).
• HbA1c associated with CVD, kidney disease (nephropathy), and retinal eye
damage (retinopathy) – inflammation of walls and vessels.
Blood glucose:
Glycohemoglobin (HbA1c):
≥ 126 mg / dL
------------------------------------------< 126 mg / dL
≥ 6.5%
------------------------------------------< 6.5 %
≥ 100 mg / dL
-----------------------------------------< 100 mg / dL
≥ 5.7 %
-----------------------------------------< 5.7 %
Diabetes and Inflammation …
Inflammation – natural response to trauma and/or infection.
• Chronic inflammation overwhelms physiological systems = functional
impairment.
Sugar
Elevated blood sugar
Release of cytokine
interleukin-6 (IL-6)
C-Reactive Protein
release
Attaches to collagen (protein) =
glycosylation = inflammation
Activates immune
response
Increases risk of heart
attack (4½x)
Harvard School of Public Health (ongoing)
Nurse’s Health Study (n= 75,000)
• 761 had either been diagnosed with or
died from heart disease
1984 – 1994
• Strong correlation between highglycemic carbohydrate diet and CVD.
• High-carbohydrate diets (especially high sugar = 2x increase in heart attack risk v.
moderate-carbohydrate diets)
Fructose and Disease …
Fructose in Body
Liver – Conversion to Glucose
Excess = Fat
Minimal use as Fuel
Released as Triglycerides
(deposition)
Stored in Liver
Fructose Research:
• With equal intakes as glucose (25% of daily kcal) = more abdominal (visceral)
and liver fat with fructose
o Glucose = more subcutaneous fat.
o Fructose = elevated dyslipidemia (Triglycerides – TG increased 10%;
elevated LDLs).
• Increased liver fat = Non-alcoholic Fatty Liver Disease (NAFLD) – cirrhosis.
o Insulin passes from pancreas via liver into circulation. NAFLD = liver
insulin resistance – liver fails to recognize insulin = increased insulin =
diabetes.
Fructose and Disease …
Fructose Research (cont.):
• Increased leptin (hormone suppressing appetite) resistance in brain (less
passes into brain).
o Also due to increased TG levels.
o Equals increased caloric intake and obesity.
• Dementia.
o Elevated insulin levels shrink # insulin receptors in blood-brain-barrier.
o Less insulin effect = less glucose enters brain = elevated cortisol
(damages hippocampus).
o Insulin can help clear beta-amyloids (peptide plaques – associated with
Alzheimer’s) – less insulin effect = less clearance.
• Increased levels of uric acid in joints (gout):
o Less hepatic (liver) ATP production = more uric acid.
Fructose and Disease …
Food
Fructose (to total sugar)
Glucose (of total sugar)
Glucose (dextrose)
0.0 %
100.0 %
Plum
39.4 %
60.6 %
Apricot
42.0 %
58.0 %
Peach
46.4 %
53.6 %
Maple Syrup
48.5 %
51.5 %
Brown Sugar
49.5 %
51.5 %
White Sugar (Cane sugar)
50.0 %
50.0 %
Honey
50.5 %
44.5 %
Orange / Orange Juice Concentrate
51.0 %
49.0 %
Strawberry
51.8 %
48.2 %
Banana
50.0 %
50.0 %
Pineapple
51.0 %
49.0 %
Grape / Grape Juice Concentrate
52 – 53 %
48.0 %
Mango
53.4 %
46.6 %
Papaya
61.0 %
39.0 %
Apple / Apple Juice Concentrate
66.5 %
33.5 %
Pear
67.3 %
32.6 %
Agave
56 – 92 %
8 – 44 %
Sugar v. Sweetener…
Which do you choose?
• Safest sweeteners:
o Sugar alcohols – erythritol.
o Stevia leaf extract (minus acesulfame-K).
o Neotame.
• Moderately Safe:
o Sugar alcohols (xylitol, maltitol, sorbitol).
o Sucralose.
• Avoid:
o Aspartame.
o Saccharin.
Your Turn …
Think-Pair-Share – Quick Quizlets.
• Question 1: Describe one structural and one functional difference
between glucose and fructose.
• Question 2: Define current nutritional guidelines for sugar.
• Question 3: Identify possible mental health concerns associated
with fructose.
• Question 4: Briefly describe how fructose can lead to an increased
risk developing diabetes.
Emerging Research in Fats
Fats
Research
Fats …
Omega 3/6 Polyunsaturated Fats
Biologically-active compounds (eicosanoids) derived from PUFAs
(larger fatty acids: 18 – 22 carbon length).
• Omega-3 and Omega-6 fatty acids = essential fatty acids.
•
•
•
•
•
•
•
Healthier Eicosanoids (Omega-3)
Unhealthier Eicosanoids (Omega-6)
Eicosapentaenoic Acid (EPA) – n-3; 20:5
Docosahexaenoic Acid (DHA) – n-3, 22-6
Alpha-linolenic Acid (ALA) – n-3, 18:3
Gamma-linolenic Acid (GLA) – n-6, 18:3
Linoleic Acid (LA) – n-6; 18:2
Arachidonic Acid (ADA) – n-6; 20:4
Gamma-linoleic acid – n-6; 18:2
Omega-3 FA
Omega-6 FA
Blood vessel / airway dilation.
Reduced blood clotting (blood thinning).
Improved blood lipid profiles.
Reduced coronary vessel inflammation.
Reduced levels of inflammatory agents in
circulation (e.g., cytokines).
Improved cell wall permeability.
Gradual slowing of cellular aging.
•
•
•
•
Many of the opposite.
Cell growth (brain, muscles) – ADA (animal
and dairy fats).
Inflammatory markers (PGE1) to trigger
acute immune response.
Nervous system functioning – myelin
sheaths.
Fats …
DHA
Diet (e.g. flaxseed)
Diet (e.g. Corn)
ALA
LA
EPA
ADA
• LA required for production of inflammatory markers (e.g., PGE1 messenger) –
triggers acute immune responses.
• LA also converts to ADA.
o Large quantities of ADA = PGE2 messengers (chronic pain / inflammation).
• EPA (omega-3) manufactures PGE3 messengers – turn off inflammatory
process.
LA
Gamma-linolenic acid (GLA)
Delta-6-desaturase
(enzyme).
ALA
EPA
Relatively useless
Omega-3 FA.
• Excessive LA conversion to GLA reduces ALA
conversion.
• Conversion rates (at best) = 8 – 20%, but western
diets (high omega-6s) = 1 – 5%.
Fats …
•
Omega-3 Sources
Omega-6 Sources
EPA & DHA
Fish oils (salmon, mackerel, trout, krill, anchovies)
Corn, peanuts, safflower, sunflower, grains.
ALA
Vegetable sources (e.g., flaxseed, chia, canola oil)
Ideal Ratios: 1-to-1 to 3-to-1 ratios
between O-6 and O-3.
ALA MUST be converted to EPA/DHA:
o Conversion rates (at best) = 8 – 20%, but western diets (high omega-6s) = 1 – 5%.
Sources of DHA/EPA
Mg / 3 oz.
Sources of ALA
Mg / Tablespoon
Cod
134 mg
Pumpkin
51 mg
Catfish
151 mg
Olive Oil
103 mg
Haddock
203 mg
Walnuts (Black)
156 mg
Clams
214 mg
Soy
1,230 mg
Flounder
426 mg
Rapeseed (Canola)
1,300 mg
Pollock
460 mg
Flaxseed
2,350 mg
Flatfish
498 mg
Walnuts (English)
2,575 mg
Tuna (canned)
733 mg
Chia Seed
3,000 mg
Salmon
1,825 mg
Flaxseed Oil
7,250 mg
Fats …
1 Tablespoon:
Low O-6: ALA ratio
High in MUFAs
Dietary Fat
Saturated Fatty
Acid (SFA)
Monounsaturated
Fatty Acid (MUFA)
Linoleic Acid
(omega-6) - PUFA
Almond Oil
Avocado
Canola (Rapeseed)
Chia Seed
Coconut Oil
Cocoa Butter
Corn Oil
Cottonseed Oil
Flaxseed Oil
Grape Seed Oil
Hemp Oil
Margarine – Reg.
Olive Oil
Palm Oil
Palm Kernel Oil
Peanut Oil
8.1 %
19.8 %
7.0 %
10.3 %
86.7 %
59.6 %
13.0 %
25.7 %
9.3 %
12.5 %
9.5 %
17.5 %
14.0 %
49.6 %
81.6 %
17.7 %
69.9 %
70.0 %
62.0 %
9.4 %
5.9 %
33.1 %
27.5 %
17.9 %
17.9 %
17.4 %
12 %
49.0 %
72.8 %
37.0 %
5.9 %
45.9 %
17.7 %
10.2 %
19.2 %
18.8 %
1.5 %
2.9 %
52.9 %
51.6 %
15.7 %
68.5 %
55.0 %
31.5 %
9.6 %
8.9 %
1.5 %
31.8 %
High in O-6
Alpha Linolenic
Acid (omega-3) PUFA
< 1.0 %
< 1.0 %
9.2 %
57.1 %
< 1.0 %
< 1.0 %
1.4 %
< 1.0 %
57.1 %
< 1.0 %
22.5 %
2.0 %
< 1.0 %
< 1.0 %
< 1.0 %
< 1.0 %
Fats …
1 Tablespoon:
Low O-6: ALA ratio
High in MUFAs
High in O-6
Dietary Fat
Saturated Fatty
Acid (SFA)
Monounsaturated
Fatty Acid (MUFA)
Linoleic Acid
(omega-6) - PUFA
Pumpkin Oil
Rice Bran
Safflower Oil
Sesame Oil
Soybean Oil
Sunflower Oil
Vegetable
Shortening
Walnut Oil
Wheat Germ Oil
9.0 %
17.4 %
7.4 %
14.0 %
15.5 %
12.0 %
28.0 %
32.5 %
48.5 %
75 %
40.0 %
22.9 %
83.6 %
44.4 %
52.5 %
35.0 %
12.6 %
41.5 %
50.7 %
3.6 %
24.3 %
Alpha Linolenic
Acid (omega-3) PUFA
5.5 %
< 1.0 %
< 1.0 %
< 1.0 %
6.6 %
2.9 %
2.0 %
8.8%
18.1 %
22.8 %
25.5 %
52.9 %
50.9 %
10.3 %
5.0 %
Beef Fat
Chicken Fat
Butter
Lard (pork fat)
49.6 %
29.9 %
64.6 %
39.1 %
41.9 %
44.9 %
26.5 %
45.3 %
3.1 %
19.7 %
3.5 %
10.2 %
< 1.0 %
< 1.0 %
< 1.0 %
< 1.0 %
Fats …
Optimal
Total Cholesterol
LDL
HDL
Triglycerides
< 200
< 100
≥ 40 (≥ 60 ideal)
< 150
100 – 129
Near Optimal
Borderline High
High
Very High
Ratios:
200 – 239
130 – 159
150 – 199
≥ 240
160 – 189
200 – 499
≥ 190
≥ 500
Total Cholesterol : HDL = < 5.5 -to-1
LDL : HDL = < 2.7 -to-1
• When assessing risk – avoid examining just total cholesterol score:
Total Cholesterol (TC) = HDL + LDL + (TG ÷ 5).
Example:
• HDL = 65 mg/dL; LDL = 125 mg/dL; TG = 125 mg/dL – TC = 215 mg/dL.
Fats …
Current Beliefs – do you agree?
• Cholesterol in foods (e.g., eggs, dairy) elevates cholesterol levels in the body.
• Dietary fats do not improve HDL-cholesterol levels – effect of exercise,
gender, alcohol.
• Saturated fats increase LDL-cholesterol levels = increased CVD risk.
• High fat diets increase LDL-cholesterol levels = increased CVD risk.
• High HDL-cholesterol levels reduce risk of CVD.
• CVD risk is influenced more by HDL- and LDL-cholesterol levels, and less
by triglycerides.
• High carbohydrate diets improve lipid profiles.
Fats …
New Research on Lipids:
• On LDL-cholesterol levels:
o Small (dense) LDL-subtype particles can easily penetrate the arterial wall.
o Large, LDL-subtype particles resemble fluffy, cotton balls – too large to
penetrate arterial walls – do not increase risk of CVD.
o Saturated fats elevate large subtype of LDL-cholesterol.
• On HDL-cholesterol levels:
o Does elevated HDL cholesterol lower risks for heart disease?
o Small risk-lowering effect ONLY.
o Eating saturated fats elevates HDL-cholesterol levels.
Fats …
New Research on Lipids:
• On Total Cholesterol : HDL ratios (TC:HDL):
o Unsaturated fats replacing saturated fats in the diet DO lower TC:HDL
ratios.
o Carbohydrates replacing saturated fats in the diet DO NOT change
TC:HDL ratios.
 But, the effect of carbohydrate + unsaturated fat has 2x larger effect
on improving TC:HDL ratios than just adding saturated fat to the
diet.
o Replacing trans-fats with any other fats or a carbohydrate + fat
combination does improves TC:HDL ratios.
• On Triglycerides:
o Carbohydrates added to the diet elevated TG levels – elevated TG are
associated with increased CVD and diabetes risk.
Fats …
New Research on Lipids:
• On Medium Chain Triglycerides (MCTs):
o Fats are easily absorbed – pass to liver.
o Lauric acid increases HDL-cholesterol, but also raises total cholesterol
and TC:HDL levels.
o Coconut Oil:
 Highly saturated, but 50-60% MCT (lauric acid) with remaining
40% being long chain, saturated fatty acids.
 Believed to elevate metabolic rate (60 kcal) with 1 – 2 TBL / day.
 Believed to have small appetite suppressing effect.
Weight Loss
Study:
• 2 TBL v. soybean oil.
• No weight loss difference
after 3 months.
Heart Health
Study:
• 20% kcal from coconut
oil.
• 8% LDL increase (5
weeks)
Dementia
•
•
•
MCTs convert to Ketones with
Alzheimer’s – brain loses capacity
to metabolize glucose
Ketones provide necessary fuel.
No strong evidence with coconut
oil.
Fats …
The A-List
Type of Fat
Compounds
Examples
Polyunsaturated Fats
• Omega 3’s
• ALA with good ratios
• Flaxseed Oil, Canola
Oil
• Almonds & Walnuts
Monounsaturated Fats
• Lower Risk for CVD
• Olive Oil, Canola Oil
The Avoid List
Type of Fat
Trans-fats
Compounds
• Hydrogenated
compounds
Examples
• Any listed as Trans-fats
Highly Saturated Fats
• Long-chain saturated fats • Beef, Butter, Lard, Palm
Kernel Oil
Certain Vegetable Oils
• Fats with poor O-6 to O3 ratios
• Corn oil, Safflower oil, Sesame
oil, Peanut oil
•
Effect of high carbohydrate diets and lauric acid risk on CVD appear to be uncertain.
•
Effect of saturated fats on CVD risk appears to be debatable.
Your Turn …
Think-Pair-Share – Quick Quizlets.
• Question 1: Are EPA/DHA and ALA found in foods the same?
• Questions 2: Why do we need to monitor our Omega-6 fat intake
in relation to creating healthy levels of Omega-3 fats in the body.
• Question 3: How can one improve their overall lipid profile?
Energy Pathways – Overview
FATS - Triglycerides
CARBOHYDRATES
Fatty Acids + Glycerol
Glucose / Glycogen
Aerobic
Anaerobic
The Energy Pathways …
The Energy Pathways
Aerobic
Anaerobic
Large Energy Source
Produces Energy Slowly
Uses all 3 Macronutrients
Limited Energy Source
Produces Energy Rapidly
Uses Carbohydrates Only
Time of Maximal
Performance
100 90
80
70
60
50
40
30
20
10
0
20
30
40
50
60
70
80
90
100
% Anaerobic
% Aerobic
0
10
The Energy Pathways …
FATS - Triglycerides
CARBOHYDRATES
Fatty Acids + Glycerol
PROTEIN
S
Glucose / Glycogen
Amino Acids
D
Deamination
E
Glycolysis
H
Glucogenic
Lactate
I
Ketogenic
Pyruvate
Sarcoplasm
Mitochondria
B
Beta Oxidation
A
Acetyl-CoA
Ketone Bodies
G
F
C
Electron Transport Chain
Ammonia
Krebs Cycle
Urine
Urea
J
Macronutrient Fuels …
Amino acids classified as Glucogenic or Ketogenic:
• Ketogenic: Can only be converted to intermediate products that feed into
metabolic pathways to make energy or fats (FFAs).
o When and why?
o Demand for energy > rate of energy production if carbohydrates are lacking.
• Glucogenic: Have ability to be converted to glucose (manufacture of glucose
from non-carbohydrate source = Gluconeogenesis).
o When and why?
o Glucose needed for red blood cells and liver; glycogen depletion in cells;
Demand for energy > rate of energy production if carbohydrates are lacking.
Ketogenic
Glucogenic/Ketogenic
Glucogenic
2 L’s:
• Leucine (EAA – BCAA)
• Lysine (EAA)
PITTT:
• Phenylalanine (EAA)
• Isoleucine (EAA – BCAA)
• Threonine (EAA)
• Tryptophan (EAA)
• Tyrosine (NEAA) – from
Phe
• Histidine (EAA)
• Valine (EAA – BCAA)
• 10 NEAA
The Energy Pathways …
Ketone Bodies
Acetoacetate
Beta-hydroxybutyrate
Fuel – Almost all organs
(not liver, not RBC)
Acetone
Survival during food-deprived periods
After 72 hours CHO depletion:
• Brain derives ~25% energy from
ketones
• Can increase to 70% in 6 weeks.
Acetone = waste product – excreted via urine/breath.
• Produced from acetoacetate breakdown (within 5 hours if not used for energy).
• Contributes to some weight loss in ketogenic diets – excreted = 150 – 250 kcal / day via
urine / breath (‘fruity’ acetone breath).
• Brain = 2 % of body weight (3- 4 lbs.), but consumes 20 % of RMR / up to 25 % of
blood glucose.
o When brain feeds off ketones v. glucose – alters ratio of glutamate (excitatory NT)
to GABA (inhibitory NT) = less brain excitation (epilepsy) / fogginess.
Metabolism and Breakfast …
Fasted Cardio?
Idea – morning workout to burn more fat.
• Example: 300 kcal session:
• 180 kcal from fat to 240 kcal from fat = 60 more fat kcal.
• 3,500 kcal = 1 lb. fat (requires 58 sessions).
Fats
(60%)
Fats
(80%)
But at what cost???
CHO
(20%)
Dinner – Carbohydrates
• Muscle and liver glycogen filled.
• Evening activities – bedtime.
• Overnight fast – bodily functions:
o Muscle can’t release glucose to blood.
o Liver’s role is to maintain blood glucose.
CHO
(40%)
Muscle
Liver
Muscle
Liver
Muscle
Liver
Metabolism and Breakfast …
Metabolism and Breakfast
Fasted States:
• Results = increased cortisol:
o Promotes lipolysis (fat breakdown) – needs carb byproduct.
o Inhibits glycolysis (carbohydrate breakdown).
o Stimulates gluconeogenesis (breakdown of certain proteins).
• Outcomes:
o Ketone production (incompletely metabolized fats) = sweet smell (not
harmful in small quantities – but do compromise lactate buffer.
o Possible protein breakdown = ammonia smell.
o Elevated cortisol can suppress metabolism.
Muscle
o Elevated cortisol can damage hippocampus in brain.
o Metabolic Survival States
Solution – eat some carbs to reduce Cortisol.
Liver
Liver
Your Turn …
Think-Pair-Share – Quick Quizlets.
• Question 1: Why does the body produce ketones – are they
harmful in moderate dosages?
• Questions 2: Why would the body need to utilize proteins within
the energy pathways?
• Question 3: Why is breakfast so important?
• Question 4: What science is lacking from the popular concept of
fasted, morning exercise?
HIIT Solutions
True HIIT
Solutions
New Approaches and Ideas…
Duration of Event
Event Intensity
Primary Energy System
0 – 6 seconds
Extremely High
Phosphagen
6 – 30 seconds
Very High
Phosphagen and Fast Glycolytic
30 – 120 seconds
High
Fast Glycolytic
2 – 3 minutes
Moderate
Fast Glycolytic and Oxidative
> 3 minutes
Lower
Oxidative
Phosphagen System
100%
Fast Glycolytic
System
75%
Percentage
Contribution of the
Energy Pathway 50%
Aerobic System
25%
0%
0
10s
30s
120s
Duration of Maximal Performance Exercise
New Approaches and Ideas…
Fast Glycolytic System
CARBOHYDRATES
(Glucose/Glycogen)
ATP = Energy + ADP + Pi + H+
Glycolysis
(ANAEROBIC)
Pyruvate
Lactate- + H+
AEROBIC RESPIRATION
Larger Amounts of
Energy
Small Amounts
of Energy
New Approaches and Ideas…
Muscle
Lactate (Lactate- + H+) cannot
remain in muscle (shuts down)
Sodium Bicarbonate buffer
(NaHCO3)
Blood
Lactate (Lactate- + H+) lowers blood
pH (7.35 – 7.45)
Recovery within
Blood !!!
What about Circuits?
New Approaches and Ideas…
Trending: HIIT workouts – why?
• Weight loss belief – potentially increased
caloric burn during session + EPOC
(afterburn)?
• Time-efficiency* – shorter workouts (e.g., 3x20
sec, 3x / week – Timmons, UK)
o Up to 90 % less training volume (amount
of work performed)
o Up to 67 % lower training time
• Improved performance – aerobic and anaerobic
improvements (Tabata, 1996)
• Improved health* – blood glucose control
• Increased metabolism* – fat burning ability
* Research focused primarily on HIIT, not HVIT
New Approaches and Ideas…
Do you Understand?
HIIT
HVIT
Defined by maximal or near maximal
performance (movement quality)
Defined by some measure of effort
(movement quantity)
Objectively measured
Subjectively measured
Example: best 40-yard sprint time (e.g., 5
seconds)
Example: Pushing hard possible under
fatigue, but 40-yard dash in 7-seconds
Work interval shorter than recovery
interval
Work interval longer or same duration as
recovery interval
Goal = improve performance
(bigger, stronger, faster)
Goal = questionable
Calories, but at what cost?
As intensity drops, so does kcal burn rate
New Approaches and Ideas…
Maximal 60-sec
Performance (N=8)
Work Interval
Recovery
Workout 1 (HIIT)
Workout 2 (HVIT)
Mean: 320 watts
Mean: 320 watts
5 Intervals (1-to-3 ratio)
 60-sec @ 288 watts (90%)
10 Intervals (1-to-1 ratio)
 Interval 1 – 2 @ 288 watts (90%)
 Interval 3 – 4 @ 233 watts (73%)
 Interval 5 – 6 @ 192 watts (60%)
 Interval 7 – 8 @ 160 watts (50%)
 Interval 9 – 10 @ 135 watts (42%)
180-sec recovery @ 75 watts
60-sec recovery @ 75watts
Total Duration
20-min
20-min
Calories – work
18.7 kcal / min
10.3 (9-10) – 18.7 kcal / min (1-2)
Calories – recovery
7.0 kcal / min
7.0 kcal / min
198.5 kcal
211.6 kcal
?
?
7.8 (subjective)
5.8 (subjective)
Total Kcal
EPOC
Experience
New Approaches and Ideas…
Work
Recovery
Recovery
Recovery
Work
Recovery
Recovery
Recovery
Work
Recovery
What are we supposed to do during recovery intervals?
Work Interval
Recovery Interval
Type II fibers
Type I fibers
Lactate shuttle
Active pump
• Transition from Type II fibers (anaerobic ) to type I (aerobic) or change
modality?
• How?
o Stabilization exercises.
o Balance and postural control.
o Aerobic activities.
New Approaches and Ideas…
Using Active Recoveries
Triset (mini-circuit):
• Bb Clean and Press (45-sec).
• Db Side Lunges with upward trunk rotations (30-sec each way).
• Single Leg Db RDL with bilateral rows (30-sec each way).
~ 165 seconds of work = 1:2 (330 sec recovery)
Active (generalized or whole-body) recovery – lactate buffer
Active Recovery:
• Light Movement – walking (30-sec) + transition (15-sec).
• Plank Walk-ups (30-sec) + transition (15-sec).
• Rotational Planks (30-sec) + transition (15-sec).
• Single-leg Leg Swings and Hip Drivers (3D) (30-sec per leg) + transitions (15 sec).
• Turkish Get-ups (30-sec each side) + transition (15-sec).
• Light Movement – walking (45-sec).
• Prep for next set (30-sec).
Tri-set (mini-circuit):
• Bb Deadlift (45-sec).
• Standing Kb Rear Rotational Presses (30-sec / side).
• Multi-planar Kb Goblet Lunges (60-sec).
New Approaches and Ideas…
VIIT: Variable-intensity interval training
• Mixed pursuit of:
o High-intensity (performance) intervals – more HIIT intervals = calories +
EPOC
o Overall improved technique = reduced injury potential
o Positive experiences
Watch performance – objective work output,
technique or decrement in performance
Work
Recovery
Work
Recovery
Work
Recovery
Work
Recovery
Work
Recovery
New Approaches and Ideas…
Watch performance – objective work output,
technique or decrement in performance
Or consider hybrids:
• Variable Interval Training (VIT) / Variable Recovery Training (VRT)
• Variable Modality Training (VMT)
Work
Integrated:
Recovery
Work
Recovery
Recovery
Recovery
Work
Recovery
1
2
3
4
5
5-10 min
5-10 min
5-10 min
5-10 min
5-10 min
Work
6
Recovery
7
5-10 min 5-10 min
Your Turn …
Think-Pair-Share – Quick Quizlets.
• Question 1: How do the work-to-recovery ratios differ between
True HIIT and HVIT workouts (what fitness industry describes as
a HIIT workout)?
• Question 2: Identify one growing concern associated with HIITstyle training?
• Question 3: What is one fundamental difference between true HIIT
and a VIIT workout?
• Question 4: What unique differentiator exists between a VMT
workout and a HIIT workout?
Upper and Lower Movement
Mechanics
Upper Extremity
Lower Extremity
Movement Mechanics …
Shoulder Abduction
Frontal Plane Action
Application:
• Internally rotate the arms and abduct as high as possible – notice end ROM.
• Externally rotate the arms and abduct as high as possible – notice end ROM.
Difference?
• Impingement of greater tuberosity (humerus) against coracoid process (scapula) – space
is generally small (~ 5-10 mm).
Implications for Movement:
• Caution against excess shoulder abduction with internal rotation = bursitis and tendonitis
(supraspinatus and biceps long head).
• Example: Upright rows, front and lateral raises.
Movement Mechanics …
Shoulder Abduction
Scaption Plane Action
Application:
• Perform a lateral raise movement with the arms in the frontal plane – notice any
resistance to movement?
• Perform a lateral raise movement with the arms 30° forward in the frontal plane –
notice any resistance to movement?
Difference?
• With arms 30° forward to frontal plane, greater tuberosity falls in line with highest
point of coraco-acromial arch - experiencing least amount of resistance.
Implications for Movement:
•
Perform lateral raises with slight external rotation or forward 30° in frontal plane.
•
Example: Moving from 3 / 9 o’clock position to 4 / 8 o’clock position for shoulder
flexion exercises (press, lat pull-down, lateral raises).
Movement Mechanics …
Overhead Press
Frontal Plane Action
Application:
• Three heads offer anterior, middle and posterior containment of shoulder (lowered
position).
• Place index finger and thumb over origin and insertion points of anterior deltoid perform overhead raise movement.
Difference?
• Observe external rotation of humerus - changes muscle’s orientation.
• Arm lowering - no anterior stabilizer to prevent anterior humeral displacement
(exacerbated with behind the head presses).
Implications for Movement:
• Overhead positions – External humeral rotation creates no anterior containment beyond
passive structures – need to engage lats as stabilizers.
Movement Mechanics …
Scapulohumeral Rhythm
Force-Coupling Vectors
Direction, Magnitude and Timing
Movement application?
• 180° abduction - scapular and glenohumeral (GH) joint movement ratio = ~ 2to-1.
o 2° of GH motion for every 1° of scapular motion (120°-to-60° ratio).
• True scapulae movement = 45 – 60° upward rotation coupled with:
o 20 – 40° posterior tilt.
o 15 – 35° external rotation.
o All designed to reduce encroachment into sub-acromial space.
Movement Mechanics …
Scapulohumeral Rhythm
Scaption Plane Action
Glenoid fossa (GF) is ⅓ size of the gleno-humeral head (GH)
• Golf ball & tee analogy - labrum increases socket depth by 50 %.
• Due to GF-GH shape, rotator cuffs (RC) collectively coordinate GF-GH movement:
o Compress, depress, stabilize and steer the humeral head within socket constrained within 1-2 mm of center of glenoid fossa (creates ICR).
o Also function to clear humerus from acromion process.
RC muscles play important role in initiating movement and facilitating humeral inferior
glide.
Muscle
Function
Supraspinatus
Abduction + compression/depression during
arm elevation + slight external rotation (ER).
Infraspinatus +
Teres Minor
ER + compression/depression during arm
elevation.
Subscapularis
Internal rotation (IR) +
compression/depression during arm elevation
Movement Mechanics …
Scapula dyskinesis:
• Represents imbalance in stability-mobility relationship.
o Ineffective joint positioning; general lack of neuromuscular control of
scapulae (altered muscle activation patterns).
Causes
Inappropriate or
deficient
training
Repetitive
trauma
(overuse)
Improper
posture / poor
positioning
Structural /
congenital
issues
Degenerative
changes
Shoulder Program Overall Goal
• Improve parascapular stability – promote T-spine mobility & movement
efficiency
Movement Mechanics …
Phase One: Promote Thoracic Mobility
• Address planes sequentially:
o Sagittal Plane 1st – Frontal Plane 2nd – Transverse Plane 3rd – most problematic.
Never compromise lumbar stability !! – demonstration
• Thoracic Spine Demonstrations:
o Supine foam-roller.
o Supine arm movement – short-to-long lever (progress to prone – short lever).
 Examples: Alphabets – “I”, “Y”
o Spinal twists with rib-grab.
o Thoracic matrix (Gary Gray).
Movement
Thoracic
Lumbar
Flexion
30 – 40°
40 – 45°
Extension
20 – 30°
25 – 35°
Lateral Flexion
20 – 35°
20°
Rotation
35 – 45°
10 – 15°
Movement Mechanics …
Phase Two: Promote ST Stability
• Focus: ST position & control (stability), not GH movement
o Parascapular muscles best stabilized with CKC exercises (joint compression
– muscles function as stabilizers).
o Too challenging initially?
o Start with OKC exercises
o Demonstrations – use supported surfaces (e.g., floor, wall) + kinesthetic
feedback ‘feel’
 Shoulder Packing (reduce scapular elevation)
 Reverse Codman’s – short lever (alphabets)
 Supine Letters – short lever (“I-Y-T-W”, “Wipers”)
Retract
Depress
Movement Mechanics …
Exercise Progression (cont.).
• Open-chain – elbows bent, and remain below shoulder-level.
o Movement in all 3 planes (push/pull, mash and scrub).
o Use supported surfaces (e.g., floor, wall) + kinesthetic feedback ‘feel.’
o Reverse Codman’s – short lever (alphabets).
o Supine Letters – short lever (“I-Y-T-W”, “Wipers”).
• Progress CKC exercises:
o Wall presses – 3D shifts and scapular clocks.
CKC Presses
Scapular Clocks
Quadruped Loading – progressions:
Move loading positions:
•
Loading and 3-D weight shifts
•
12 o’clock (depression).
•
Off-set hand position
•
6 o’clock (elevation).
•
Elbow extension
•
3 o’clock (retraction).
•
Lengthen moment arm
•
9 o’clock (protraction).
•
Unstable surfaces
Movement Mechanics …
Transverse Plane Action
Prior to heel strike instant:
• Supination = calcaneal inversion to create rigidity in foot for initial contact.
During heel strike instant:
• Chain reaction dissipate forces upwards, thus impact forces (from heel strike) must be absorbed
and dissipated.
o Pronation utilizes elastic energy of the longitudinal arch.
o Pronation = calcaneal eversion creates spaces between tarso-metatarsal joints to help
absorb forces.
Demonstrations:
1. Hands on thighs.
2. Glute activation.
Mechanics:
1. Internal tibial vs. femoral
rotation = valgus stress (ACL).
Heel strike – supination
Joint Protection:
Passive: Deltoid, MCL ligaments
Active: Glutes, lateral hip complex
Movement Mechanics …
Frontal Plane Action
Weight transference to stance-leg during gait.
•
During load response instant – body experiences a weight shift over stance-leg while preserving
optimal alignment between the hip, knee and foot.
o 1 - 2” lateral hip shift + small hip tilt (~ 4 - 5°).
Knee stability is maintained via collaborative actions of:
•
Stance-side gluteal group + contralateral (opposite) quadratus lumborum.
•
Muscle weaknesses = increased probability of knee injury.
Demonstrations:
1. Hip shift to single-leg
with hands on hips.
Mechanics:
1. Hip and trunk control to maintain alignment and avoid excessive
hip adduction.
Quadratus
Lumborum
Gluteal
Group
Movement Mechanics …
Seated Hip Abduction / Adduction:
• Aesthetics v. Function?
o Aesthetics – you cannot overcome estrogen’s role of fat deposition in thigh
region – more muscle tone may help.
o Function:
 Normal hip abduction = 45° and normal hip adduction = 20°.
 Machines force angles > 45° = altered pelvic position and lumbar
stress.
 Gluteus medius function – concentric or eccentric?
− Lifestyle (e.g., holding child) and knee consequences.
− Preferred exercises – balance/core = kcal + function.
Movement Mechanics …
Sagittal Plane Action
Hip flexion = 110 – 120° of flexion an average of ~ 95° needed during bend-and-lift movements.
•
Individuals exhibit ‘glute-dominant’ or ‘quad-dominant’ patterns.
•
MUST shift pelvis posteriorly during the downward phase to facilitate adequate hip flexion.
Glute Dominant
Quad Dominant
Muscles
Glutes, hamstrings, calves
Quads
Gender
Male generally
Female generally
1st 10 - 15° of downward phase =
pushing hips backwards (“hip-hinge”)
1st 10 - 15° of downward phase = shearing
forces increasing across knee (quadriceps
try control anterior tibial translation).
Movement
Demonstration:
1. Hands over
hamstrings with
two movements
Eccentric Hamstrings pull
Women and knee Injuries:
1. ACL injury potential = 4-6 x greater in females vs. males in same sport.
2. ~ 70 % ACL injuries = non-contact (jumping, landing, stopping,
directional change).
Although tibia is more fixed in closed kinetic chain, the
hamstrings help control anterior translation of the tibia
Movement Mechanics …
Key Areas of Emphasis:
• Promote Ankle Mobility
Ankle
(mobility)
Knee
(stability)
Hips
(mobility)
• Limitations:
o Supination/Pronation – Subtalar joint (talus-calcaneus
o Dorsiflexion/Planta flexion – Talocrural joint
o Inversion/Eversion – tarso-metatarsal joints (cuboid/navicular)
Movement
Mortise
ROM
Dorsiflexion
20°
Plantar flexion
45 – 50°
Inversion
20°
Eversion
10°
Ankle (Structure) Mobilization for Mortise:
• Stand on elevated platform with strap or elastic wrapped around talus –
anchored downward.
• Move into dorsiflexion.
Movement Mechanics …
Ankle
(mobility)
Knee
(stability)
Hips
(mobility)
Key Areas of Emphasis:
• Promote knee stability:
o Unloaded (body weight)
 Hamstrings (sagittal) – Knee Flexor or Extender?
 Gluteus Maximus (transverse plane)
 Gluteus Medius (frontal plane) – Open- v. Closed-chain?
o Progress to Jump-landing mechanics (cheek-to-cheek, nose-over-toes).
•
Promote hip mobility:
Movement
ROM
Hip Flexion
110 – 120°
Hip Extension
10 – 15°
Hip Abduction
40 – 50°
Hip Adduction
20 – 30°
Stability-Mobility – NASM Overhead
Squat
Stability
Mobility
Stability-Mobility
NASM Overhead
Squat
Stability-Mobility …
• Fundamental trait we all share –move efficiently.
o Efficient movement requires appropriate stability, while simultaneously
promoting appropriate mobility.
Stability
Ability to maintain or control
joint movement or position.
Must Never
Compromise Each
Other
Mobility
Arthrokinetics
(joint movement)
Movement
Efficiency
Neural
Control
(software)
Possess uninhibited ROM
around a joint or body segment
Muscle
Properties
(hardware)
Stability-Mobility …
Let’s examine walking – from heel strike to toe-off.
Stability-Mobility …
Foot is highly adaptable: Rigid lever to mobile adaptor.
•
•
•
•
Calcaneal position at – heel strike (examine your shoe-wear pattern – why?).
Calcaneal position at heel strike (supination).
Calcaneal position at load response (pronation).
Calcaneal position at toe off (supination).
Calcaneus = horse…
Talus = saddle…
Tibia/Fibula = rider…
Stability-Mobility …
What Happens if the Body Loses / Lacks these Properties?
• Step One: Law of Facilitation = ‘Dyskinesis’
o Compensation: Compromised stability to facilitate mobility.
o Compensation: Movement into other planes.
 Example: Seated Leg Extension – why?
 Example: Bird-dog – why?
• Step Two: Loss of stability = injury potential.
o Chronic overuse injuries versus acute injuries.
Low back – stable !
Knees – stable !
Shoulder girdle – stable !
80 – 90% of all adults
200,000 ACL injuries/year.
70 – 75% non-contact.
21% of population with 40%
persisting < 1 year
$100 billion annually
$650 million (surgery +
rehabilitation)
$39 billion annually
Stability-Mobility …
NASM Overhead Squat
Integrated movement between two extremities - bend-and-lift
coupled with an overhead reach.
• Consider qualifying your client for the overhead squat with an overhead
reach FIRST!
Instructions:
• Stand against support surface (e.g., wall) – try to rest sacrum,
shoulders and head (not necessarily feet).
• Observe shoulder blade position and back of head – alignment.
• Relax arms at sides – observe arm position.
Score
1
2
Description
Pain indicated and unable to perform the movement.
• Shoulders don’t make contact (i.e. shoulders in flexion,
anterior tilt, or protraction).
•
Head does not make contact (i.e., forward head position).
•
Arms do not lie adjacent to side of body.
•
Arms are not extended (i.e., elbow extension).
Stability-Mobility …
Instructions:
• Slowly move arms overhead to end-range of motion
• Observe quality and quantity of movement in shoulders and back.
Score
3
3
4
Description
Arms:
•
Fail to reach 170 – 180° of shoulder flexion.
•
Arms move into different plane (demonstrations).
• Identify bilateral asymmetry in arm movement.
Trunk:
•
Loss of contact of 3 anchor points (head, shoulders, sacrum) from support.
•
Increased lumbar lordosis – observe ball movement or decreased BP pressure.
• Trunk movement in frontal or transverse plane to achieve end-ROM.
Completes at least 2 repetitions with good form.
Stability-Mobility …
Desired
Movement?
Observe
Validate
• Identify desired
• Explain – demonstrate
planes of movement
– practice trials
• Identify regions of
• Observe movement
stability and mobility efficiency and
throughout kinetic
limitations
chain
Lever (bone)
Joint
Lever (bone)
Educate
• Identify where
• Coaching /
(locations and
correcting movement
movement
breakdown)
• Identify why
(possible reasons)
Lever (bone)
What has happened here?
What happens to muscles
on this side of joint?
What happens to
muscles on this side
of joint?
Lever (bone)
What needs to be done?
Stability-Mobility …
NASM Overhead Squat
Repetition
1st repetition: •
2nd repetition:
3rd repetition:
•
•
What to Observe
Front View
Observe the stability of the foot (i.e., evidence of pronation or
supination).
Observe the alignment of the knees over the 2nd toe.
Observe the overall symmetry of the entire body over their base of
support (i.e. any evidence of a lateral shift or rotation).
• Movement: Feet remain stable (i.e., no movement) – movement is through the
ankle.
• Observe: Feet during the movement.
• Validate: Why would they move? What does this now mean?
Feet Turn Out
Where are you tight muscles?
Ideal
Compensation
Stability-Mobility …
NASM Overhead Squat
Repetition
1st repetition:
2nd repetition:
3rd repetition:
What to Observe
Front View
• Observe the stability of the foot (i.e.) evidence of pronation or
supination, eversion or inversion.
• Observe the alignment of the knees over the 2nd toe.
• Observe the overall symmetry of the entire body over their base of
support (i.e. any evidence of a lateral shift or rotation).
• Movement: Middle of each knee remains directly over your 2nd/ 3rd toe – knees
move in the sagittal plane.
• Observe: Knees during the movement.
• Validate: Why would they collapse inward or fall outward? What does this now
mean?
Knees Fall Inward
Where are your tight muscles?
Ideal
Compensation
Stability-Mobility …
NASM Overhead Squat
Repetition
What to Observe
Front View
1st repetition: • Observe the stability of the foot (i.e.) evidence of pronation or
supination, eversion or inversion.
2nd repetition: • Observe the alignment of the knees over the 2nd toe.
3rd repetition: • Observe the overall symmetry of the entire body over their base of
support (i.e. any evidence of a lateral shift or rotation).
• Movement: Hips remains aligned over the feet.
• Observe: Hips during the movement – best viewed from behind.
• Validate: Why would they shift? What does this now mean?
Body Shifts to One Side
Where are your tight muscles?
Stability-Mobility …
NASM Overhead Squat
Repetition
What to Observe
Side (sagittal) View
1st repetition: •
Observe whether the heels remain in contact with the floor throughout
the movement
• Movement: Feet remain stable (i.e., flat on the floor – no heel elevation) –
movement is through the ankle.
• Observe: Feet during the movement.
• Validate: Why would they move? What does this now mean?
Heels Lift Off the Floor
Where are your tight muscles?
Ideal
Compensation
Stability-Mobility …
NASM Overhead Squat
Repetition
2nd repetition:
•
What to Observe
Side (sagittal) View
Observe for ‘glute’ or ‘quad’ dominance (i.e., downward phase starts
by driving knees forward v. pushing hips backwards).
o Women = more quad dominant; men = more glute dominant.
• Movement: Hips move backwards to initiate the downward movement - the
knees move forward once hips have moved backwards
• Observe: Timing and presence of forward movement of the knees.
• Validate: Why would they move early or perhaps not move? What does this
now mean?
Knees Move Forward Immediately
What is the concern?
Compensation
Ideal
Stability-Mobility …
NASM Overhead Squat
Repetition
What to Observe
Sagittal View
3rd repetition: • Observe position of the spine – should remain neutral or flat (sacrum to
head)
• Movement: Spinal alignment at three points is maintained – head, shoulder
blades (thoracic spine) and hips (sacrum)
• Observe: Alignment of the spine during the movement.
• Validate: Why would it not maintain good alignment? What does this now
mean?
Back Arches or Bows Upward
Where are your tight muscles?
Ideal
Compensation
Stability-Mobility …
NASM Overhead Squat
Repetition
4th repetition:
•
What to Observe
Side (sagittal) View
Observe whether a parallel alignment between tibia and torso is
achieved in lowered position (i.e., figure-4 position) v. T-formation.
• Movement: Movement: Trunk/arms and tibia achieve a parallel alignment in the
lowered positon.
• Observe: Alignment between each body segment.
• Validate: Why would they not be aligned? What does this now mean?
Body Does not Attain Parallel Alignment
Where are your tight muscles?
Ideal
Compensation
Stability-Mobility …
NASM Overhead Squat
Repetition
5th repetition:
What to Observe
Side (sagittal) View
• Observe alignment between torso and arms.
• Movement: Trunk and arms maintain a parallel alignment in the lowered
positon.
• Observe: Alignment between these two body segments.
• Validate: Why would they not be aligned?
o What does this mean?
o Lats and pecs v. posterior complex (traps, rhomboids)
Ideal
Compensation
Corrective Exercise
CEX
Strategies
Corrective Exercise …
Systematic process of restoring proper levels of stability and mobility
for movement efficiency.
Stability
Must Never Compromise Each Other
Ability to maintain or control joint
movement or position.
Mobility
Possess uninhibited ROM around a joint or
body segment
Inhibit / Release
Lengthen
Strengthen
(type I fibers)
Integrate
Myofascial Release
Static Stretching
Positional Isometrics
Integration
(Mobility)
(Mobility)
(Stability)
(Integration)
Corrective Exercise …
Body’s primary
communication system.
Passive
System
Skeleton, joints (capsules),
ligaments, tendons, and skin
that offer support to regulating
movement.
Neural
Control
System
Movement
Actively
-passive
System
Contains inelastic and elastic
components that generate force, absorb
energy (from outside forces – i.e.,
deceleration), and harness energy into
movement (i.e., absorbing impact
forces eccentrically – then utilized for
concentric action).
Active
System
Fascial tissue spanning entire body at
various levels (i.e., deep, superficial) –
capable of resisting unmerited compressive
forces, yet also withstand unmerited
elongating forces (i.e., strain) – called
‘tensegrity’ (all 4 systems in unison provide
human tensegrity).
Corrective Exercise …
Inhibit
What is Fascia?
Actively-passive System
• Fascial tissue = specialized tissue different from muscle.
• Continuous throughout body at multiple levels:
o Separates tissue.
o Surface area for muscle attachment to bone.
o Able to provide stability through tension (stretching/lengthening) v. muscles with
compression/contraction.
• Contains up to 9x more receptors than muscle – sensitive to mechanical stimuli
Corrective Exercise …
Inhibit
• How does it Function? Mennel’s Truisms.
o Meatball-plate analogy.
o When joint is NOT free to move – muscles moving joint do not function
optimally = dysfunction within muscles .
o Muscle function cannot be restored if joints are not free to move.
o Myofascial release (MR) focuses on neural-fascial systems – alleviates
myofascial trigger points (knots) and areas of hyper-irritability to improve
soft tissue extensibility and function.
 Knot = fibers out of alignment – MR relaxes and aligns fibers.
Corrective Exercise …
Inhibit
Foam Rolling
Methodology #1 – Foam Rolling
•
•
•
Compression
Techniques
Methodology #2 – Compression Techniques
Identify trigger areas (tender spot).
•
Roll over segment or 3-6” area of
•
localized tenderness for approx. 30 sec
•
(> 30 reps) until discomfort subsides.
Little discomfort (not pain) = appropriate
(feel good-pain)
Perform 1 – 2 sets
1 – 2x per muscle per day
Identify trigger areas (tender spot).
Apply load (body weight)
Move joints or move body over
compression points
o Sagittal = Roll
o Frontal = Mash
o Transverse = Scrub
Perform up to 10 reps/movement direction
1 – 2x per muscle per day
Corrective Exercise …
Static (passive) Stretching
• Modality: Low-force, longer-duration stretch that slowly increases muscle
length.
GTO activation
Immediate low-grade muscle
spindle (MS) activity
Inhibits MS activity
(temporary increase in muscle tension).
Low-grade muscle response quickly
decreases (MS desensitization) as stretch
duration progresses (first 5 seconds).
After 7 – 10 seconds, muscle tension
activates GTO response
Allows for inelastic
tissue stretching
(creep / remodeling)
Hold for 5 – 50
additional sec
Total stretch: 4
x 15-60 sec
Principle known as
Autogenic Inhibition
Corrective Exercise …
Ever notice how after ~10 seconds, you feel less resistance
within the stretched muscle?
• Application: to effectively stretch muscle, you need at least 7-10 seconds
just to shut down nerve activity before you can actually apply a stretch
load (strain) to the connective (muscle) tissue.
o Guidelines: 4 reps x 15 – 60 sec each.
• After removing stretch stimulus, MS quickly re-establishes stretch
threshold again.
o ~ 70 % MS recovery within 1st 5 seconds.
• Application: Perform repetitions with minimal recovery between each rep.
Static Stretching Turns Off Muscle Activity
Corrective Exercise …
Muscle Activation Techniques (MAT)
Another technique to turn on or turn off muscles
• Modality Example: Low-grade isometric contractions (50 % of maximum
force for 6 - 15 seconds) reduces MS activity within active muscle (agonist)
after contraction and also within opposite (antagonistic) muscle.
o In same muscle = Autogenic Inhibition

o
Example: Activation of glute maximus temporarily inhibits MS after
contraction – follow with stretch of that muscle.
In opposite muscle = Reciprocal Inhibition.

Example: Activation of glute maximus temporarily inhibits MS activity
within iliopsoas (hip flexors) – follow with stretch of antagonistic muscle.
Important to initiate the stretch immediately following inhibition of the muscle
spindle due to its rate of recovery.
Corrective Exercise …
Strengthen
Type I Fibers
Type II Fibers
Force Production
Low-force, longer
duration
Higher-force,
shorter duration
Primary Energy
Pathway
Aerobic
Anaerobic
Role
Stabilizers (tonic)
Mobilizers (Phasic)
• Located in greater concentrations closer to spine – stabilization role
o What type of training is preferred?
 Higher-force, shorter duration..?
 Lower-force, longer-duration..?
Corrective Exercise …
Strengthen
Positional Isometrics (PI)
Position
Frequency
Neutral
3 – 5 days/week
Sets
Minimum 1
Reps
Start with 4
Tempo
Minimum 4-sec hold
Tempo
2-sec rest
Intensity
Start between 25 – 50 % of maximal intensity.
Dose-related Effect
Integrate = Foundational Training
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Visit NASM Booth 1017 in the FitExpo Hall to receive discount
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Core Essentials in Exercise Science
THANK YOU..!!
Fabio Comana
Fabio.comana@nasm.org
For Your Commitment to
Excellence
www.nasm.org
Questions... ??
Core Essentials in Exercise Science